Spinal Cord Injuries
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Spinal cord injuries (SCI) happen with a traumatic event that damages the cells in the spinal cord or nerve cells within the spinal cord A. 12,000 to 15,000 people are affected with spinal cord injuries with 10,000 people being paralyzed B. Spinal cord injuries cause loss of function to the spinal cord which can be loss of mobility or feeling C. Not all spinal cord injuries cause severing of the spinal cord but can still cause loss of function 1. If the vertebra are injured, but not the spinal cord there will be no paralysis D. Some examples of spinal cord injuries are: 1. Motor vehicle accidents (44.5%) 2. Falls with individuals older than 44 years (18.1%) 3. Violence (16.6%) 4. Sport Injuries (12.7%): i.e. diving E. There are two types of SCI: 1. Complete- no function below the level of the injury; there is no sensation or voluntary movement (paralysis), meaning both sides of the body are equally affected 2. Incomplete- some functioning below the primary level of injury, unequal movement of limbs, some limbs may feel different from others, or functioning on one side of the body could be more: more common Diagnosis/Prognosis A. Traumatic Spinal Cord Injury (SCI) 1. Usually present signs of: a. Immediate loss of strength b. Numbness in legs and arms 2. One can predict signs due to the location of the injury on the spinal cord. a. Cervical section- Damage affecting the legs, arms and trunk. b. Thoracic section- Damage affecting mostly the legs and trunk. c. Lumbar and Sacral section- Damage affecting the legs. B. Non-traumatic SCI (Most common) 1. Usually present signs of: a. Weakness and numbness which is hard to predict the area that is affected. C. Physical Exam: 1. General Exam is given 2. Neurological Exam is given a. American Spinal Injury Association Examination (ASIA) is commonly given. This tests specific sensory and motor skills. D. Prognosis 1. Injury includes from the site injured and downwards. (i.e: C1-C4 loss includes breathing, arm control, trunk control, and leg control). a. C1-C4 May need breathing assistance b. C5- No wrist or hand control, some shoulder and bicep control c. C6- Includes some wrist control, no hand control d. C7 and T1- Can straighten arms, lacking in hand and finger control
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e. T1-T8- Most often include hand control, lack of trunk control f. T9-T12- Have most trunk control, can balance sitting up g. Lumbar and Sacral- Loss includes hip flexor and leg control 2. Injuries can cause other problems a. Bowel and bladder dysfunction, loss of sexual function b. Loss of autonomic control c. Mens fertility is affected and womens mostly is not d. Low blood pressure and reduced control of temperature e. Inability to sweat below the injury f. Chronic pain E. Vocabulary 1. Quadriplegia- Cervical neck injuries that generally cause paralysis of all arms and legs. 2. Paraplegia- SCI causing paralysis of the legs and sometimes the trunk, but not the arms. Injury from T1 and below. There are different treatments for different types of SCI. Time is the crucial factor in determining the seriousness of the outcome. A. Pharmacologic Therapy 1. Administer high-dose corticosteroids a. Methylprednisolone B. Respiratory Therapy 1. Administer oxygen a. Maintain high arterial PO2 to prevent hypoxemia 2. Diaphragmatic pacing a. Stimulate diaphragm to help patient breathe C. Skeletal Fracture Reduction and Traction 1. Tongs a. Involve fixation of skull b. Traction 2. Halo devices a. Immobilization of cervical spine and early ambulation D. Surgical Management 1. Performed to reduce spinal fracture or dislocation or to decompress the cord a. Surgery indicated if: i. Compression of cord is evident ii. Injury results in fragments or unstable vertebral body iii. Injury involves wound that penetrates the cord iv. There are bony fragments in the spinal cord v. The patients neurologic status is deteriorating
Work Cited
1. (2009). Quadriplegia. Spinal Cord Injury Network. Retrieved March 25th, 2009, from
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2. Bare, B.G., & Smeltzer, S.C. (2004). Brunner & Suddarths textbook of medical-surgical nursing (10th ed.). Philadelphia: Lippincott Williams & Wilkins. 3. Danziger, P Spinal Cord Injuries. Retrieved March 14, 2009, from Spinal Cord Injuries Web site:
[Link] 4. Huether, S, & McCance, K (2008). Understanding Pathophysiology: Alterations of Neurologic [Link]. Louis: Mosby. 5. J. Glen House, MD. (2009).How to diagnose. Spinal Cord Injury. Retrieved March 25th, 2009, from [Link]